Pleura Effusion

PLEURA EFFUSION

A. Congeniality
Effusion of Pleura is heaping of cavity dilution of pleura (I Schwartz seymour, 2000).
Effusion of Pleura is gathering of abnormal dilution in pleural cavum (Wise [of] Mansjoer, ed. 1999).
Effusion of Pleura is gathering of dilution in room of pleura which lay between surface of and visceral of parietal. (Suzanne C Smeltzer and of Brenda G. Bare, 2002

B. Etiology
According to Selbacher, dkk (2000) etiology of pleura effusion that is as follows: pleura dilution accumulate if pleura dilution forming exceed pleura imbibition dilution. Normally, dilution enter pleura cavity from capillary in panetalis pleura and transported to tissue of limfatik located in parietalis pleura. Dilution also can enter pleura cavity room of interstisium pulmo through viseralis pleura or from peritoneum cavum through puncture exist in diaphragm. channel of limfe have capacities under normal circumstances. For the reason, pleura effusion can be formed if there is forming of dilution of pleura abundant (parietalis pleura, pulmonary interstisium room, or peritoneum cavum) or if there is degradation transportation of dilution by passing limfatik, normal pleura dilution is 15-20 cc.
According to Wisdom of Mansjoer, ed (1999) etiology of pleura effusion shall be as follows:
1. Neoplasma like bronkogenik neoplasma and of metastatik
2. Cardiovascular like failing heart of kongesti, pulmonar embolus, and perikarditis
3. Disease at abdomen like pankreatitis, asites, and abscess
4. Infection caused by bacterium, virus, mushroom, parasite and mikobakterial
5. Others systematical eritematosus like lupus, arthritis rheumatoid, syndrome of nefrotik and of uremia.

C. Classification of pleura effusion pursuant to formed dilution (Suzanue C Smeltezer and of Brenda G. Bare, 2002)
1. Transudat
Representing plasma filtrat emiting a stream of to penetrate intact capillary wall, happened if factors influencing and forming of reabsorbsi pleura dilution annoyed that is because pressure imbalance of hidrostaltik or ankotik. Transudasi designate the condition of like asites, perikarditis. Disease kongestik heart failur or fail kidney so that happened heaping of dilution.
2. Eksudat
Ekstravasasi dilution into tissue or cavitas. As effect of inflammation by bacterium or humor product which hitting the pleura for example TUBERCULOSIS, chest trauma, virus infection. Pleura effusion possible represent komplikasi kongestif heart fail. TUBERCULOSIS, pneumonia, infection of paru, nefrotik sindroma, bronkogenik karsinoma, hepatis serosis, embolism of paru, infection of parasitik

D. Patofisiologi
Change of dilution movement into and exit of pleura cavity caused by the existence of hydrostatic pressure imbalance and colloid osmotic pressure in capillary surface and pleura.
Difference between eksudat and transudat relied on its trasudat protein content (hidrotoraks) produced when dilution free of protein emit a stream in pleura cavity become annoyed. Visible dilution pure or turn pale yellow. Specific gravity 1,015 or less with normal protein content less than 3 gr/dl, calculate corpuscle type. Make-Up of capillary pressure at failing heart and onkotik pressure reduction plasma in kidney or hepar disease have been known to cause dilution of transudat.

E. Sign and Symptom
1. Trakea deviasi avoid hit side
2. The impelling of mediastinum at adversative side with dilution
3. Deaf at percussion
4. Degradation of sound respiration of hit side at auskultasi
5. Out of breath or short breath
6. Chest pain of pleuritik (blunt feeling in chest)
7. Noisy of heart at heart weakness
8. Weaken progressive, downhill body weight
9. Cough sometime bleed at smoker (Bronchus Karsinoma)
10. Fever of Subfebril (tuberkulosis)
11. Anxietas (liver cirrhosis)

F. Supporter Diagnosa
1. Inspection of laboratory (effusion dilution analysis which in thorakosentesis)
2. Inspection of radiology
Thorax photo seen the corner loss of kostofrenikus and will seen tortous surface if amount of effusion dilution more than 300 ml, friction of mediastinum sometime found .
3. Chest CT Scan will seen difference of dilution densitas with vinicity tissue
4. Ultra Sono grafi at pleura can determine pleura cavity dilution
5. Bronkoskopi at cases of neoplasma, aleunum korpus and abscess of pulmo
6. Thorakoskopi (pleura optic tiber) at case with pleura tuberculosis neoplasma
7. Biopsy of Pleura.


G. Threatment
1. Dilution drainage if effusion of pleura generate symptom of subjek, pain, dipsnea, etc. Dilution effusion counted 1-1,5 litre released immediately to prevent to to improve oedema. Amount of more effusion dilution hence expenditure of dilution following conducted 1 hour later.
2. Antibiotic if there are emprema
3. Pleurodesis that is adhere viseralis pleura and pleura parietalis to prevent happening of again effusion of pleura after aspiration (effusion of pleura maligna)
4. Opreatif, when pus jell dilution difficult so that exit or its multilokulara
5. Lie down

H. Komplikasi
1. Pneumonia
2. Fibrosis Paru
3. Pneumotorak
4. Emfisema
5. Arelektasis

I. Functional Health Pattern Study
1. Activity and Practice Pattern
a. Anamnesis existence of dyspnea, weaken, or fatigue
b. At effusion area there no fremitus, gloomy percussion, breath voice decrease
c. Unsimmetrical chest ekspansi
d. Out of breath or short breath
e. Tachipnea
f. Heart noisy at heart weakness
g. Heaping return dilution after action of thorakosintesis, study sign of distress respiration
h. Kardiovaskuler respon after thorakosintesis, hipotensi, tachicarchi, aritmia, insensible, pale and sweaty husk
i. Bronkhopulmonary infection: temperature, sputum for the culture of and of sensitivitas
2. Sleep and rest pattern
a. Habit of sleep
b. Condition of sleep
c. Time got off to sleep
d. Quality of sleep
e. Moment sleep trouble
f. Habit of deliverer of sleep.
3. Cognate Perception pattern
a. Existence of sigh of chest pain
b. Perception of pain in bone, PQRST pain
c. Intensity scale mount pain.

J. Nursing Care Plan
1. Ineffective Breath Pattern related to degradation of pulmo ekspansi (Heaping of dilution).
Target of
a. Client can reach normal respirasi status by way of clean breath.
Indikator 1 2 3 4 5
- Easy to breath
- Syspnea after exercise
- Normal chest expantion
- Not anxiety
- Good condition
- Reguler breath pattern
- RR normal
Boldness:
1 : Very inappropriate
2 : Seldom according to
3 : Sometime according to
4 : Often according to
5 : Always according to

b. Client can reach normal vital marking status
Indikator 1 2 3 4 5
- Temperature
- Perifer pulse
- Central perifer
- RR
- Diastolik
- Sistolik
Boldness:
1 : Most digressing from normal
2 : Digressing many from normal
3 : Digressing from normal
4 : Light digress from normal
5 : Do not digress from normal
Intervention:
- RR Observation, breath pattern, breath deepness effort and respiration
- Observation result of chest rongten
- Give air numidifikasi/oxygen if precisely
- Positioning balmy patient on course to maximize ability of breathing
- Teach patient for breathing slow and regular
- Teach family and patient about usage of O2 at home
- Colaborate with family for observation and know symptom and sign in change respiration and report at health team

2. Ineffective Airway Breathing
That is disability in cleaning or secretion of bronchi obstruksi to take care of cleanness airway breathing
Characteristic definition:
- Dispnea
- Degradation of breathing voice
- Orthopnea
- Breathing voice additional: rales, creakles, ronkhi, wheezing
- Ineffective cough/cannot cough
- Production of Sputum
- Sianosis
- Difficulty talking
- Change of respiration frequency and ritme
- Jumpy
Coresponding Factor :
- Environment
- Smoke
- Smoke Cigarette
- Inhalaksi Smoke
- Passive Smoker
Obstruksi airway
- Spasme airway
- Mucus many
- Ineffective sekresi
- Existence of artificial respiration way
- Foreign object in airway
- Sekresi in bronkus
- Eksudat in alveoli
Physiology
- Disfungsi Neuromuscular
- Hyperplasia Wall of bronchial
- Disease of kronik obstruksi paru
- Infection
- Asthma
- Allergic
Target : Client can reach status of respirasi normal with ventilation after conducted treatment during …..hours
Criterion result of
Indikator 1 2 3 4 5
- Regular breathing
- Breath rythm normal
- No noisy breath voice
- Easy to breath .
- Orthopnea is never
1 : very it to
2 : always it to
3 : often it to
4 : sometime it to
5 : expectation inappropriate
Intervention:
Management Respiration:
1. Observing deepness rhythm level and effort in breathing
2. Observing exhalation sound
3. Teaching technique of relaksasi special
4. Auskultasi breath voice
5. Give O2

3. Acute Pain related to biological injuri agent
Target: client can reach balmy level.
Indikator 1 2 3 4 5
- Comfortable physic
- Reporting to satisfy to ability control x'self / symptom and sign
- Reporting psychical freshment.
- Comfort with the environment
- Comfort with the relationship
- Satisfy to its independence
- Satisfy to ability control pain
Boldness:
1 : Have never demonstrated
2 : Seldom demonstrate
3 : Sometime demonstrate
4 : Often demonstrate
5 : Always demonstrate
Intervention:
1. Analgesic Administration
- Determining location, characteristic, quality of and degree of pain before giving drug
- Monitor vital sign before and after giving analgesic at first time
- Give timely analgesic especially super pain moment
- Effectiveness evaluation of analgesic, symptom and sign (side effects)
2. Pain Management
- Conduct pain study comprehensively cover characteristic location, onset, durasi, frequency, quality of, factor and scale.
- Teach good relaksasi and distraksi technique before, moment or after pain
- Report at doctor if given pain handling less effective
- Give optimal analgetik drug to lessen pain
- Kolaborasi with one who mean with patient, other health team to determine pain management to non invasif action.

4. Less knowledge about disease process related to
- Lack of information
- Mistake of information interpretation
- Cognate delay
Target: Client can know about its disease process
Indikator 1 2 3 4 5
- Knowing the name of disease
- Can explain about the disease
- Can explain about the risk factor
- Can explain about the sign and symptom
- Can explain about the complication
Boldness:
1 : Cannot
2 : Seldom can
3 : Sometime can
4 : Often can
5 : Always can
Intervention
1. Teach: disease process
- Descripting disease sign and symptom
- Explaining disease process and identify cause
- Intruct to client to report sign and symptom
- Discussing about therapy.


SOURCE

Doengoes, Marllyn E. Rencana Asuhan Keperawatan, 2000.
Isselbacher, et.al. Harison Prinsip-prinsip Ilmu Penyakit dalam, Edisi 13. Jakarta: EGC. 2000.
Mansjoer, Arif ed.et.all, Kapita Selekta Kedokteran, Jilid 1. Edisi 3. EMdia Aesculapius, FKUI: 2001.
Nanda Nursing Diagnoses Definitions and Clasification, Philadelphia. 2002.
Nettina, Barbara M. Pedoman Praktik Keperawatan Alih Bahasa. Setiawan Sari, Monica Ester, Jakarta: EGC. 2002.
Schwartz, Saymour I, Intisari Prinsip-prinsip Ilmu Bedah. Jakarta: EGC. 2000.
Smeltzer, Suzanne C. Buku Ajar Keperawatan Medikal Bedah. Jakarta: EGC. 2000.